Midterm results after the mini-maze procedure

Szalay, Z.; Skwara, W.; Pitschner, Heinz F.; Faude, I.; Klövekorn, W. P.; Erwin, P Bauer

doi:10.1016/s1010-7940(99)00208-0

Cited by 27 publications

(14 citation statements)

References 19 publications

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“…Cardiac tamponade has rarely been reported in patients undergoing the MINI procedure concurrently with CABG; one patient has been reported in literature in multiple articles [4], and the complication does not appear to be directly attributable to the MINI procedure but rather ascending aortic rupture. As such, this case appears to be the first to report cardiac tamponade in absence of CABG with the MINI procedure.…”

Section: Discussionmentioning

confidence: 99%

“…When successful, these procedures result in restoration of normal AV nodal transmission of atrial depolarization, thereby improving ventricular diastolic function and cardiac output. Cardiac rate is lowered when AF is converted to normal sinus rhythm [4]. If combined with left atrial appendage ablation, the nidus for thromboembolism is eliminated and the risk for stroke is reduced [1–3].…”

Section: Introductionmentioning

confidence: 99%

“…Anticoagulant therapy (commonly warfarin [8]) is recommended for three months following any Maze procedure due to the risk of recurrent AF and the possibility of embolus [2]. Maze procedures are associated with postoperative atrial arrhythmias, fluid retention, pancreatitis, hemorrhage, pneumonia, and, in rare cases, cardiac tamponade [1, 2, 4]. Cardiac tamponade is compression of the heart, most commonly by fluid, preventing the filling of the right atrium and ventricle.…”

Section: Introductionmentioning

confidence: 99%

“…The adverse effects of cardiac tamponade include hypotension, syncope, severe exercise intolerance, pulseless electrical activity, cardiac arrest, and death. Cardiac tamponade has been reported in fewer than 1 % of maze procedures [2, 4]. Extra-pericardial cardiac tamponade has yet to be reported following any maze procedure.…”

Section: Introductionmentioning

confidence: 99%

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Extra-pericardial tamponade following Wolf Mini-Maze procedure: a case report

Bailey

2015

J Cardiothorac Surg

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BackgroundExtra-pericardial tamponade is a rare life threatening condition that has not previously been reported in association with Wolf Mini-Maze procedures. In this case, atypical presentation of cardiac tamponade caused by postoperative anticoagulation resulted in a second hospitalization, a second surgery, and delayed recovery time. The goal of this case report is to increase awareness about a life threatening complication that can occur following minimally invasive cardiac surgery.Case PresentationA 60 year old male with long standing essential hypertension, who was recently treated for atrial fibrillation utilizing the Wolf Mini-Maze procedure, experienced a postoperative international normalized ratio increase from 3.6 to 5.3 over the course of six days. Fifteen days postoperatively, the patient experienced mild exercise intolerance, his condition rapidly progressed to a constellation of symptoms including severe exercise intolerance, dyspnea, hypotension, and near syncope. A diagnosis of cardiac tamponade was made, and the patient was re-admitted to the hospital. Attempts to reverse his warfarin anticoagulation with fresh frozen plasma and vitamin K were unsuccessful after 24 h. Video-assisted thoracotomy was performed to relieve the tamponade, and during surgery he was diagnosed with extra-pericardial tamponade caused by an extensive hematoma. Complications due to anticoagulation therapy required this re-admission, additional surgery, and delayed recovery. The patient has since recovered completely with no long term morbidities and is asymptomatic three years following initial presentation.ConclusionsThis case marks the first time extra-pericardial tamponade has been reported post cardiothoracic intervention in English literature. Many surgical procedures require postoperative anticoagulation; in the past, warfarin has been the standard of care due to its purported reversibility. This case provides an example of the challenge presented when anticoagulating with warfarin, and the reversal of this anticoagulation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extra-pericardial tamponade following Wolf Mini-Maze procedure: a case report

Bailey

2015

J Cardiothorac Surg

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“…The concepts regarding the mechanism of AF have further evolved with studies indicating that intermittent AF originates from ectopic focuses in the pulmonary veins. Catheter ablation techniques or surgery involving isolation of mainly the pulmonary veins have been founded on these concepts (17-20). Because fibrillation surgery is an additional procedure to the main cardiac procedure, cardiopulmonary bypass and cross clamp times might be prolonged.…”

Section: Introductionmentioning

confidence: 99%

Epicardial Microwave Application in Chronic Atrial Fibrillation Surgery

et al. 2005

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The search for alternative epicardial energy sources in the treatment of nonvalvular atrial fibrillation (AF) is a relatively new aspect of the evolving spectrum of Maze operations. We tested the hypothesis that epicardial microwave ablation produces identical results to those of the standard cryosurgical Maze. Fourteen consecutive patients with chronic AF underwent on-pump epicardial Maze procedures after routine cardiac surgery. The results were compared with those of 14 control patients selected from our Maze database of 280 patients. There were no differences in age, sex, cardiothoracic ratio, duration of AF, pump time, intensive care unit or hospital stays. The aortic cross clamp time with epicardial microwave was, however, shortened from 110 to 65 minutes (p=0.011). The recurrence rate of AF after discharge showed no significant difference between the two groups (14% vs. 15%, p=0.841). Epicardial microwave ablation might be a valuable alternative to the conventional cryosurgical Maze procedure, especially for those patients without associated mitral valve disease.

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The Mini‐Maze Operation

Szalay¹

2008

Manual of Surgical Treatment of Atrial Fibrillation

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Midterm results after the mini-maze procedure

Abstract: Midterm results are identical after M III and MINI. MINI is less complex compared to the M III procedure and there is a significant reduction of crossclamp- and ECC-time. We recommend the MINI especially for polymorbid patients, and for those with poor left ventricular function.

Cited by 27 publications

References 19 publications

Extra-pericardial tamponade following Wolf Mini-Maze procedure: a case report

Extra-pericardial tamponade following Wolf Mini-Maze procedure: a case report

Epicardial Microwave Application in Chronic Atrial Fibrillation Surgery

The Mini‐Maze Operation

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